Korean Circ J.  2007 Jan;37(1):43-46. 10.4070/kcj.2007.37.1.43.

Delayed Rupture of Mycotic Hepatic Artery Aneurysm in a Patient with Infective Mitral Endocarditis-First Case in Korea

• Park IW
• Park TW
• Han SG
• Woo ML
• Min PK
• Cho DK
• Eun LY
• Jeong JH
• Lee KJ
• Byun KH

• KMID: 2227093
• DOI: http://doi.org/10.4070/kcj.2007.37.1.43

Abstract

Mycotic aneurysms of the hepatic artery are usually caused by mycotic infection in patients suffering with bacterial endocarditis. Mycotic aneurysms have become very rare recently due to early intensive antibiotic treatment for infective endocarditis. Despite of the non-specific symptoms, these aneurysms show a high possibility of sudden death if thye ruptured. Therefore, early detection and surgical repair of aneurysms are very important. We report here on a case of hepatic artery mycotic aneurysm that presented as sudden shock and rupture.

Keyword

Hepatic artery; Aneurysm; Rupture; Shock; Endocarditis

MeSH Terms

Aneurysm*
Aneurysm, Infected
Death, Sudden
Endocarditis
Endocarditis, Bacterial
Hepatic Artery*
Humans
Korea*
Rupture*
Shock

Figure

• 

  Fig. 1 Transthoracic echocardiographic findings of the magnified mitral valve showed a mobile echogenic mass (arrow) and an attached anterior mitral leaflet (A). The transesophageal echocardiographic findings showed irregular shaped vegetation (arrow) and prolapse before mitral valve replacement (B). LA: left atrium, LV: left ventricle.

• 

  Fig. 2 Ultrasound examination showed a pulsatile hypoechoic cystic mass in the liver (A) and the Doppler scanning demonstrated arterial blood flow in this lesion (B). The white arrow indicates the cystic mass and the white arrow head indicates the mural thrombus.

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  Fig. 3 Axial (A) and coronal CT scanning (B) showed a 4.4×4.1×5.2 cm sized aneurysm with a partially coagulated blood clot and strong contrast enhancement. The white arrows indicate the hepatic artery aneurysm and the arrow head indicates the mural thrombus.

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  Fig. 4 The operative finding showed that aneurysm of the common hepatic artery was surgically exposed (arrow heads) and a fistula was formed from the aneurysm to the common bile duct (arrow).

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